Provider Demographics
NPI:1265695662
Name:GREEN, ALLISON BROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:BROOKS
Last Name:GREEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:602 CENTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7420
Mailing Address - Country:US
Mailing Address - Phone:301-829-6588
Mailing Address - Fax:301-829-6338
Practice Address - Street 1:602 CENTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7420
Practice Address - Country:US
Practice Address - Phone:301-829-6588
Practice Address - Fax:301-829-6338
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD142821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program